Nick Mulcahy

May 20, 2015

NEW ORLEANS — Persistent symptoms characteristic of urinary tract infection (UTI) that do not improve with time or treatment could indicate bladder cancer.

That's the simple "take-home message" from a first of its kind study of UTI-like symptoms and bladder cancer, according to lead author Kyle Richards, MD, from the University of Wisconsin–Madison.

The message is for clinicians and applies to both men and women, he told reporters during a press briefing here at the American Urological Association 2015 Annual Meeting.

Awareness is especially important when it comes women, said Dr Richards, because bladder cancer is most commonly associated with men.

"A lot of primary care doctors who are [initially] seeing these [symptomatic] patients are less aware that bladder cancer is even a possibility in women," he explained.

And he pointed out that because bladder cancer most commonly presents as blood in the urine, or hematuria, UTI-like symptoms do not always raise suspicion for this cancer.

In their study — the first to look at patients with bladder cancer who present with UTIs — Dr Richards and his colleagues assessed the impact of this presentation on patient outcomes.

They report that diagnoses take longer and outcomes are poorer in men and women who present with UTIs than in men who present with hematuria.

The investigators used 2007 to 2009 data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database to identify 9326 men and 2869 women who were diagnosed with hematuria or UTI in the year before they were diagnosed ith bladder cancer.

The average time from initial symptom claim to bladder cancer diagnosis was longer in women than in men (72.2 vs 58.9 days; P < .0001).

A closer look at the data indicated that UTIs were the reason for this disparity.

In an analysis of patients presenting with hematuria alone, the time to subsequent bladder cancer diagnosis was similar for women and men (46.1 vs 47.3 days; P = .75).

However, in an analysis of patients presenting with either hematuria or UTI, time to diagnosis was significantly different. "Women had a longer interval from UTI to diagnosis of bladder cancer," Dr Richards reported.

On logistic regression analysis, women presenting with a UTI were more likely to have advanced (pT4) pathology at diagnosis than men presenting with hematuria (odds ratio [OR], 2.79; 95% confidence interval [CI], 2.04 - 3.83). The same same pattern was seen for men presenting with a UTI (OR, 2.08; 95% CI, 1.56 - 2.79).

On Cox proportional hazards analysis, risk for bladder-cancer-specific and overall mortality was higher in women presenting with a UTI than in men presenting with hematuria (hazard ratio [HR], 1.72; 95% CI, 1.46 - 2.03). The same pattern was seen for men presenting with a UTI (HR, 1.41; 95% CI, 1.28 - 1.56).

"Symptoms of urinary tract infection in older patients might be a harbinger of bladder cancer, and misdiagnosis may lead to inferior oncologic outcomes," the authors write in their meeting abstract.

Don't just chalk it up to urinary tract infection.

The message was reinforced by Tomas Griebling, MD, MPH, a urologist from the University of Kansas in Kansas City, who moderated the press briefing.

When there are persistent symptoms, "don't just chalk it up to urinary tract infection," he said. There is a tendency to do so because they are so common, he explained.

"The money and resources spent on UTIs eclipses everything else we do [in urologic diseases]," he noted, including prostate and bladder cancer.

In fact, in the United States, "the numbers are astronomically higher" for UTIs, Dr Griebling emphasized.

The delay in diagnosis in women is understandable because their urologic care is typically delivered by primary care physicians and Ob/Gyns, said Dr Richards.

"A lot of women don't get to see a urologist until it's much later in the process," he said, "whereas men are apt to see a urologist."

Dr Richards has disclosed no relevant financial relationships. Dr Griebling reports financial relationships with Medtronic and Pfizer.

American Urological Association (AUA) 2015 Annual Meeting: Abstract PD23-10. Presented May 17, 2015.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.